Podiatry Coding & Billing Alert

Question: I hear all the time that I should be looking at the Medicare Physician fee schedule to figure out the payment we'll get for our claims. But I don't understand what columns to look at. Can you explain what the following column headings mean: non-facility price, facility price, nonfacility limiting charge, and facility limiting charge? New Hampshire Subscriber Answer: First, the difference between facility and nonfacility fees is based on where your physician is performing services. Medicare will pay you the facility fee whenever your doctor is not paying market rent for the space, such as in a hospital, ambulatory surgery center, or nursing home. The non-facility fee applies when your physician is assuming the cost of the space and the personnel at fair market pricing, as with an office. The limiting charge is the maximum amount a physician or practice can charge for a physician's services when [...]